Dehnen Dorothea, Flägel Kristina, Wild Dorothea, Steinhäuser Jost
University of Duisburg-Essen, Medical Faculty, Institute of General Practice, Essen, Germany.
University Hospital Schleswig-Holstein, Institute of Family Medicine, Lübeck, Germany.
GMS J Med Educ. 2025 Jun 16;42(3):Doc38. doi: 10.3205/zma001762. eCollection 2025.
2021 saw the publication of the new version (2.0) of the "National Competency-based Catalogue of Learning Objectives (NKLM) in Undergraduate Medicine", which in future will be closely linked to the German medical licensing regulations (ÄApprO). Included in the updated catalogue are specifically defined competencies concerning practical clinical skills. We aimed to determine how residents perceive their competency level to perform selected practical clinical skills in the NKLM 2.0.
In June 2022, all 593 medical residents registered at the competence centers for postgraduate training in primary care in North Rhine, Westphalia-Lippe and Schleswig-Holstein were invited to participate in an online survey. The participants were asked to retrospectively self-assess (1) their proficiency level (5-point Likert scale) at the beginning of their postgraduate training in regard to 36 practical clinical skills from the NKLM 2.0 and (2) where they had gained proficiency in those skills. Of the 164 participating residents, the main focus was on those who had been licensed for less than five years.
The responses of 47 residents were analyzed. For 29 skills, at least 20% of the participants stated that these had not been proficiently mastered at the start of postgraduate training; e.g., examining the spine of an adult (19.6%) or the skin (37.0%). For 14 skills - such as examining female and male genitalia and those of newborns and infants - more than 50% of the participants indicated that they had not been able to perform these skills.
The results provide initial evidence that discrepancies may exist between the level of desired competency by the end of undergraduate medical education, as specified by the NKLM, and the level of proficiency actually achieved in terms of practical clinical skills. More teaching and feedback methods may need to be established to impart these skills during undergraduate medical education and to integrate these skills into complex clinical contexts.
2021年发布了新版（2.0版）《本科医学专业基于能力的学习目标目录（NKLM）》，该目录未来将与德国医学许可法规（ÄApprO）紧密相关。更新后的目录包含了关于临床实践技能的具体定义能力。我们旨在确定住院医师如何看待自己在NKLM 2.0中执行选定临床实践技能的能力水平。
2022年6月，邀请了在北莱茵-威斯特法伦-利珀和石勒苏益格-荷尔斯泰因的初级保健研究生培训能力中心注册的所有593名医学住院医师参加在线调查。参与者被要求回顾性地自我评估：（1）在研究生培训开始时，他们在NKLM 2.0中的36项临床实践技能方面的熟练程度（5点李克特量表）；（2）他们在哪些方面获得了这些技能的熟练程度。在164名参与的住院医师中，主要关注那些获得执照不到五年的人。
分析了47名住院医师的回复。对于29项技能，至少20%的参与者表示在研究生培训开始时没有熟练掌握这些技能；例如，检查成年人的脊柱（19.6%）或皮肤（37.0%）。对于14项技能，如检查女性和男性生殖器以及新生儿和婴儿的生殖器，超过50%的参与者表示他们无法执行这些技能。
结果提供了初步证据，表明NKLM规定的本科医学教育结束时所需的能力水平与实际在临床实践技能方面达到的熟练程度之间可能存在差异。可能需要建立更多的教学和反馈方法，以便在本科医学教育期间传授这些技能，并将这些技能融入复杂的临床环境中。
